Personal journey exploring mental illness and suicide

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When I first came to the UK, I thought of myself as nothing more than a human being, a doctor, a mother. I came here with one suitcase full of books, inappropriate clothes and lots of dreams. Over the years, slowly, through events good and not-so-good, I was made aware that I was a ‘female doctor from ethnic minorities’. Others may see me thus but I still see myself as a human, a doctor, a mother.

Before our world was invaded by a microscopic organism, we were divided. Identity politics dominated all conversations. ‘Vegans’ wanted to convert me to their religion. ‘Vegetarianism’ just wasn’t good enough. Fingers were being pointed at seemingly evil ‘middle aged white men’, as if they were all the same. I found myself defending them in public as I am on the inside. I am married to one of the nicest of them. The ‘transgender’ community was making its presence felt in a big way. The BME and the LGBTQ++ and the sexists and the racists, the liberalists, the socialists, the nationalists and the list is endless … were firmly rooted in their fenced off, defensive little territories.

Then came the virus and we were all united in the knowledge that we were fragile creatures and we needed each other to survive. We needed to look after ourselves and each other, in ways that were more meaningful and different from before. We learnt that the mind needed as much attention if not more, than the body. We found out that we are related to everyone else on the planet whether we liked it or not. We needed to rise above our little ‘Me. Me. Me’ voices and make decisions in favour of what was good for everyone.

We found out that small things are big things. My lovely neighbour, M, left a bunch of flowers outside the door for me every week. I arranged those flowers the best I could and sent her the pictures. I wrote hand-written letters to friends from my childhood with whom I was starting to lose connection. I discovered the joy of sleeping for a few nights in a row without setting the alarm. Si and I discovered the joy of being in the house together for days, doing normal things – baking, gardening, meditation, going for a walk, reading, watching ‘The Crown’.

I say, let’s not go back to our ‘normal’ divisions and our frantic passions. Let’s take this opportunity to re-invent ourselves and the way we meet the world. Let’s not be driven by our fears and insecurities but by a sense of deep connection with ourselves, each other and the planet. Let’s take this new learning into the world we want to live in. It’s up to us.

“The past is never dead. It’s not even past.”
– William Falkner. Requiem for a Nun.

The echoes of past traumas get subconsciously played out by us in our everyday lives. Sigmund Freud called it ‘repetition compulsion’ – an attempt of the unconscious mind to replay the unresolved so that we can ‘get it right’. This mechanism drives its way through generations. Jung also noted that whatever is too difficult to process does not fade away. It gets stored in our unconscious and finds expression in other ways. He says,” When an inner situation is not made conscious, it happens outside as fate.”

Here’s an example: Jake was 19. He hadn’t slept a full night’s sleep in more than a year. He had developed dark circles around his eyes and a blank stare in them. He looked at least 10 years older. He had been a star student and a great athlete but the insomnia had left him lifeless. This thing had no explanation and none of his doctors or psychologists or naturopaths could figure it out.

It had started with Jake waking up shivering one night at 3.30 am, frightened to death. No amount of woollen clothing warmed him up. Soon, insomnia became a daily ordeal. Despite knowing that his fear was irrational, Jake was helpless and could not relax. The ‘freezing’ feeling associated with the first episode was quite peculiar.

On exploration of Jake’s family history, this story came out: His mum’s brother, Uncle Colin, whom he had never met had frozen to death at the age of 19. He was checking power lines in a storm in the Northwest of Canada. He struggled to hang on but eventually fell face down in a blizzard, lost consciousness and died of hypothermia. The family never spoke his name again.

Now, thirty years later, Jake was unable to slip into sleep at the same age as his Uncle. For Colin, letting go meant death. For Jake, falling asleep must have felt the same. Once Jake could see this link, he was able to free himself of it with the help of healing techniques taught by Dr Mark Wolynn, a neuroscientist with an expertise in breaking inherited family patterns. His book “It didn’t start with you”, describes some of these practical tools.

Scientists are now able to identify bio-markers as evidence of traumas passed down from one generation to the next. Studies on Holocaust survivors and their children have revolutionised the understanding and treatment of PTSD all over the world. Be it fear, guilt, low self-esteem or anxiety, the roots of these issues may reside in the traumas of our parents, grand-parents and even great-grandparents.

“Is it wrong that I secretly enjoy this bit very much?” asked a deeply religious young lady as she was going off to sleep as a result of having received some anaesthetic medications from me this morning.

The turmoil and the innocence of her question made me think about how much of our life is governed by what’s right and what’s wrong. On the one hand it in an important judgement to make and on the other it can be completely stifling if we take it too far. It can make us judge others and ourselves rather harshly. After all, the past and the present is witness that many thousands of innocent people having been rightfully and ruthlessly killed and ruined in the name of a ‘loving, merciful and forgiving’ God and ‘democracy and liberty’.

Being ‘right’ often does nothing more than instil a sense of false superiority, designed to control the feelings and behaviour of others and confine them and society to very narrow boundaries. People who believe they are ‘good’ and ‘right’ constantly look down upon others who may be different.

According to a story from Hindu mythology, Lord Vishnu had 2 wives – Laxmi, the goddess of fortune, and Alaxmi, the goddess of misfortune. Both of them believed they were the most beautiful. So, they asked Vishnu, “Which one of us is the most beautiful?”
Vishnu said to Laxmi, “When you arrive, you are the most beautiful.” And he told Alaxmi, “When you leave, you are the most beautiful.”
What is the correct answer? Who is really beautiful?

“Existence knows no right or wrong. The beauty of existence lies in doing what is appropriate, rather than relying on morals and ethics.The life process seems to be so chaotic and unbearable for you that you are trying to bring some silly sense of order by establishing your own principles, your own morality, your own ethics. If you bring your own silly sense of order to life, you will completely miss the magnificent order of the existence. There is no need to be orderly. Existence is in perfect order.” – Jaggi Vasudev.

About 5 months after Saagar’s passing, one of my close friends sent me a subtle message suggesting that I should be careful about what I write in my blog as a few of my work colleagues read it regularly and if I appear to be too fragile or vulnerable, it might have a negative impact on my professional life. I understood her concern. The medical profession is not known for its understanding and compassion for mental frailty in colleagues.

Dr Wendy Potts was a GP in Derbyshire who blogged about living with Bipolar Disorder on a regular basis. One of her patients read the blog and complained to her Practise. The doctor was suspended. A few weeks later she ended her own life.

Firstly, I don’t understand the basis of the complaint. Would patients complain if their GP had diabetes or cancer?

Secondly, I don’t understand the basis for suspension from work. If the doctor’s performance was not questionable, then there is no ground for that.

This is one of many examples of poor treatment of medical colleagues with mental health issues. I think we are a long way from seeing parity between physical and mental illnesses as the ones who are supposed to put that into practise are themselves caught in the stigma associated with mental illness.

(PS: apologies for not being able to insert the link to the article in a better way. The ‘link’ icon on my page doesn’t seem to work anymore. Any ideas? )

Of all developed nations, Japan has one of highest suicide rates, third only to Hungary and South Korea. In the year that Saagar died, 25,000 people died of suicide in Japan, making it 70 people per day! Shockingly, this number is more than 3 times that in the UK. Male to female ratio is nearly 2:1 in Japan as compared to 4:1 in the UK.

Why is it so?

Japan’s long tradition of “honourable suicide” makes it a noble thing to do. It is perceived as people taking responsibility for themselves.

“Isolation is the number one precursor for depression and suicide,” says Wataru Nishida, a psychologist at Tokyo’s Temple University. This is particularly applies to elderly people. Many lone deaths of elderly people are never fully investigated by the police. The almost universal practice of cremating bodies here also means that any evidence is quickly destroyed. This also means that suicide is underreported.

The Oxford English Dictionary has recently added the word hikikomori . In Japanese this term describes a type of acute social withdrawal in which a person does not leave their home or room for a period of at least 6 months. In 2010, roughly 700,000 people were living as hikikomori in Japan. Their average age was 31 years. A recent survey of young Japanese people’s attitudes to relationships and sex by the Japan Family Planning Association, it found that 20% of men aged 25-29 had little or no interest in having a sexual relationship. Technology may be making things worse, increasing young people’s isolation.

Japan is a very rule-orientated society where young people have no way of expressing their anxiety or frustration. There is an acute shortage of psychiatrists. Treatment is essentially by medication as professional psychological support of good quality is not easily available.

Until the late 1990s, depression was not widely recognised in Japan as an illness. An advertising campaign run by a pharmaceutical company called it ‘a cold of the soul’ which helped raise awareness but is now blamed for employees faking depressive illness to take time off work.

This cartoon by Torisugari is his ‘manga therapy’ according to his psychiatrist but it does help improve the broader understanding of the condition.

{“The world that had supported me up until now is breaking up and falling away! I can’t even stand up any more!” says the character, Watashi (whose name means “I” in Japanese).}

The suicide figures have started to fall over the past 3 years but the absolute numbers still remain alarmingly high.

A brain surgeon, Paul Kalanithi got diagnosed with terminal lung cancer at the age of 36. Suddenly he found himself on the other side of the table. He wrote a ‘rattling, heartbreaking, beautiful’ book about his life as a doctor and then as a patient before he died. It is called “When breath becomes air’. In it he tactfully dissects the walls that exist between doctors and patients. Having found myself on either side of the table – first as a physician and then as the mother of a severely ill child, I can completely relate with this excerpt below.

“The reason doctors don’t give patients specific prognoses is not merely because they cannot. Certainly, if a patient’s expectations are way out of the bounds of probability – someone expecting to live to 130, say, or someone thinking his benign skin spots are signs of imminent death – doctors are entrusted to bring that person’s expectations into the realm of reasonable possibility. What patients seek is not scientific knowledge that doctors hide but existential authenticity each person must find his or her own. Getting too deeply into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.”

“I had to face my mortality and try to understand what made my life worth living and I needed Emma’s (my doctor’s) help to do so. Torn between being a doctor and being a patient, delving into medical science and turning back to literature for answers, I struggled, while facing my own death to rebuild my own life – or perhaps find a new one.”

I cannot imagine what one’s options would be when diagnosed with a severe/ terminal mental illness. Saagar was unable to access his own life as he knew it and perhaps chose to find a new one.